adjustment & adaptation to illness & disability

Rehabilitation Psychology

RS2270: BSc (Hon) OT Year 2, BA (Hon) Applied

Psychology & Minor in Psychology

RS5305: MOT

Dr. Andrew Siu

What is Rehabilitation Psychology?

Science and treatment of disabling and chronic health conditions.

Encompass knowledge from several branches of psychology, including:

Social psychology,

Counseling,

Clinical psychology

Health psychology.

What you would learn …

Theories of Psychological Adjustment & Application

(1-5,9)

Interviewing persons with disabilities

(6-8)

Mental Health Issues in

Rehabilitation

(12)

Social Aspects of rehabilitation

(10,11,14)

1. Psychological adjustment to disability and chronic health conditions.

Theories of adjustment, assessment of adjustment, principles and strategies in promoting adjustment.

2. Social aspects of rehabilitation. Family issues, social support, employment, sexuality.

3. Therapeutic relationship and basic interviewing skills.

4. Mental health issues in rehabilitation.

What you would learn …

Teaching-learning Strategies

Lectures: required readings for every week

Videos: for illustration of lecture contents,

demonstrations, reflection

Tutorials: case discussion, experiential activities,

role play.

Seminar: interview a person with disability/illness

& present your analysis of the person’s

psychological adjustment & adaptation in society.

Assessment

Written Assignment (30%): case analysis;

written exercises in interviewing skills.

Seminar (30%): group presentations

Quiz (40%):

Around 100 MCQs

Based on lecture materials & readings.

Psychological Adjustment to

Illness & Disability: an Overview

RS2270, RS5305

Rehabilitation Psychology

Dr. Andrew Siu

Content

Psychosocial Impact of Chronic Illness or

Disability (CID)

Definition and Indicators of Adjustment &

Adaptation

Health-related Coping Model

Facilitating Coping and Adaptation

PSYCHOSOCIAL IMPACT OF

CHRONIC ILLNESS &

DISABILITY

Impact of Disability and Illness

Body Function

& StructureActivities Participation

Impairment Function &

Limitation

Role Assignment

& Restriction

Diagnosis Functional

Performance

Role

Performance

Medical &

Restorative

Therapies

Adaptive &

Therapeutic

Relearning

Social &

Community

Support

Assessment

Intervention

International Classification of Functioning,

Disability and Health (ICF)

ICF analysis

Psychological Impact of

Disability & Illness

Impairment:

Structural changes in anatomical,

neurophysiological mechanisms of the body

Disability:

Loss of bodily function, functional

independence; the need to relearn function

and living skills.

Psychological Impact of

Disability & Illness

Handicap:

Loss of roles, adoption of sick role

Employment difficulties & self-support

Family and/or social support

Physical barriers in community

Social discrimination & self-stigma

Key Psychological Impact

Body Image & Self-Concept

Emotional Reactions

Activation of Psychological Defense

Stress & Coping

Chronic Illness & Disability

Body Image Particular important for visible

disabilities, e.g. burns, amputation,

spinal cord injury.

Process of adaptation:

Shutting out of existence or

neglect of impaired body part

Search for illusory restoration of

body part or function

Avoid social contacts

Focus on non-impaired body parts

Gradual acceptance

Loss, Grief, and Depression

Loss of body part or function feelings of loss

and grief.

Mourning about loss depression

Prevalence of depression is at least twice in

people with disabilities, compared with non-

disabled. Many studies showed that 30-50% of

hospitalized patients are depressed.

Prolonged and recurrent sorrow and sadness, or

even suicidal

Defense Mobilization

Ego defenses are largely unconscious efforts to

protect us from anxiety or unpleasant emotions,

and to maintain a consistent self-concept.

Examples: denial, rationalization, displacement,

projection, reaction formation.

Help us to hide from the truth (or facts) but could

eventually leads to a distorted view of self.

Stress & Coping

Having a serious illness or disability could

be seen as a major stress to the person.

The person may use a variety of coping

strategies to face the illness/disability.

Coping strategies (e.g. avoidance, problem

solving, diversion, etc.) could lead to very

different outcomes in adjustment and

mental health

ADJUSTMENT & ADAPTATION

Definition and Indicators

Psychosocial Adaptation

Evolving, dynamic process through which a

disabled person gradually approaches and optimal

state of person-environment congruence.

Aspects of Adaptation, e.g.

Acknowledgement of abilities and limitations

Relearning of living skills

Enact role changes and social expectations

Acceptance of new body image

Re-establish a new self-concept

Indicators of Adaptation

Active participation in social, vocational,

and leisure pursuits.

Successful negotiation of the physical

environment.

Awareness of remaining strength and assets,

as well as limitations.

Psychological Adjustment

Sometimes used synonymously with

adaptation

Refer specifically to a particular phase (i.e.

set of experience and reactions) of the

adaptation process.

Indicators of Psychological

Adjustment

Reach and maintain psychosocial equilibrium.

Achieving a state of reintegration

Demonstrating positive self-esteem and self-concept

Positive attitudes towards oneself, others, and the disability.

Positively striving to reach life goals.

Theories of Psychological

Adjustment

Theories of Adjustment

Stress & Coping

Phase Theory of Emotional Reactions

Counseling or Change theories:

Cognitive Behavior Therapy

Self-efficacy Theory

Person-centered

Stage of Change

HEALTH-RELATED STRESS &

COPING MODEL

General Model of

Stress & Coping

(Cox & MacKay,

1976)

Model of Stress & Coping

1. Stress: internal expectations or external demands.

2. Cognitive Appraisal Primary: if the stress is beneficial, relevant

harmful, or threatening.

Secondary: Judgment of coping resources.

Re-appraisal: alter one’s perception and judgment of stress situation and coping resources.

3. Responses to Stress – cognitive, affective, & behavioral coping

Ways to Manage Stress &

Increase Adaptation

Modify expectations for self

Examine person-environment fit

Learn or strengthen coping strategies

Mobilize personal or social resources for

coping

Encourage cognitive re-appraisal of stress

and coping resources needed

Examples of (Psychological)

Coping Strategies

Behavioral

• Avoidance, diversion

• Relaxation

• Disengagement

Cognitive

• Planning

• Problem-solving

Spiritual

• Turning to religion

• Seek meaning

Emotional

• Denial

• Blame or criticize

oneself

• Rationalization

• Bargaining or

negotiation

• Ventilation, Seek social

support

• Acceptance

HEALTH-RELATED COPING

MODEL

Health-related Coping Model

I. Personal Resources

Religious beliefs

Prior health-related and coping responses

Demographic background

Personality characteristics: e.g. self-

efficacy, extroversion, optimism, internal

control, problem-solving ability and style.

II. Health-Related Factors

Onset, stage, progression of health

condition

Symptoms: pain, fatigue/energy, etc.

Disability: type & loss of function

Health care environment and treatment

procedures: invasive procedures,

examination by strangers, technical

equipment.

III. Social & Physical Context

Social:

Relationship, support, and expectations of

people in network

Physical:

Physical aspects of home, workplace,

shopping, etc. can influence person’s access,

mobility, and autonomy

Personal space, privacy, aesthetic qualities of

surroundings, etc.

IV. Cognitive Appraisal

Is the stressor (e.g. chronic illness)

expected and is the person prepared for it.

Is the problem is regarded as

Challenge or threat?

Controllable or not?

Caused by self or not? Am I responsible?

Outcome of this appraisal greatly affects

coping efforts and strategies

V. Adaptive Tasks

1. Managing symptoms

2. Managing treatment

3. Forming relationships with health care providers

4. Managing emotions

5. Maintaining a positive self-image

6. Relating to family members and friends

7. Preparing for a uncertain future

VI. Categories of Coping Skills

Coping Skills

Logical analysis & search for meaning

Taking problem solving action

Cognitive avoidance or Denial

Acceptance &

resignation

Seeking alternative

rewards

Emotional discharge

Seeking guidance

and support

Positive appraisal

VII. Health-related Outcomes

Effects of coping strategies

Stress reduction or relief

Emotions: Anxiety, depression, anger; happiness,

satisfaction.

Acceptance of new body image, having illness

Self-esteem

Growth: e.g. resilience, EQ

Social relationship: e.g. closer or alienated

FACILITATING COPING &

ADAPTATION

Promote Adaptation

Person

Environment

Transition

PhysicalSocial

Information

Values

Coping

Reappraise

roles &

functions

Facilitating Coping &

Adaptation in Persons with CID

Intervention on Physical

Environment

Promote mobility and access within client’s

life space as far as possible, e.g. home,

work, leisure contexts.

Modification of home or work environment

if necessary and feasible.

Use of technology and additional

equipment.

Work simplification and energy

conservation.

Intervention on Social

Environment

Map the social support network and assess client’s needs for various types of support (emotional, tangible, information & guidance, need for companion)

Address the issues of caregiver burden.

Encourage client to provide support to others as well, or mutual help.

Encourage social participation

Monitor ongoing changes in social support.

Intervention on the Person

Commitment and values.

Re-organization of one’s life commitment & life roles

Identify values and beliefs of the client which may promote adaptation.

Cognitive restructuring of irrational thoughts.

Find facts: Information seeking

e.g. Seek advice, knowledge, guidance, sharing of experience from others.

Facilitate Coping Responses

Find meaning: Re-appraisal

e.g. find new meaning in situation, develop

emotional competence, ongoing self-reflection.

Manage stress: Inhibition

e.g. emotional discharge, stress management,

diversion or selective ignoring.

Intervention on Transition

Cannot change the nature of transition.

Prevent the development of sick role.

Explore changes in role expectations.

Assist client to re-appraise (acknowledge,

accept, and enact) one’s changing roles and

functions.

Required Reading

Livneh, H. (1997). Psychosocial adaptation to

chronic illness and disability. Gaithersburg, MD:

Aspen Publication. Chapter 1.

Martz, E, & Livheh, H. (Eds.). (2007). Coping

with chronic illness and disability: Theoretical,

empirical, and clinical aspects. New York:

Springer. Chapter 6.

Video

《共渡經濟漩渦》香港電台電視部，2002 (Call No: 18656 VCD)

TVB Pearl (2009). Bangkok Biding. (Call

No.: 26655DVD)